PA Workers’ Compensation

Overview

In August of 1993 Pennsylvania enacted a new law governing how workers’ compensation claims were to be billed by medical providers and paid by insurance companies. These process changes also required changes to a provider’s billing, payment verification and dispute resolution processes. Many providers have not adequately adjusted to these changes and workers’ compensation claims have since become the most difficult to bill, manage and collect.

Our PA Workers' compensation Services:

our role

Fortunately, SunStone can help. We have unparalleled experience and expertise in this area. Tim Mosco, our service line leader for Pennsylvania Workers’ Compensation services, worked directly with the Bureau of Workers’ Compensation in writing the supporting regulations, developing the processes for the Bureau’s Application for Fee Review system and training of Fee Review staff. With Tim’s leadership we have been providing workers’ compensation consulting, claims-related assistance and outsourcing for over twenty years.

Hospitals that outsource their Pennsylvania workers’ compensation billing and recovery to vendors without extensive experience in Pennsylvania guidelines and regulations run significant risk of not being paid promptly, completely and in compliance. Many firms use generic billing and recovery processes that just do not work for Pennsylvania workers’ compensation claims. No other state has processes and regulations as unique as Pennsylvania’s. Our team is trained specifically for Pennsylvania workers’ compensation billing and reimbursement, and our process is intensive and comprehensive.

Our Process

Prior to billing any claim, our team will do the following:

Verify the claim details with the employer.

Compile all of the required billing documents.

Submit billing documents and follow up if no payment or denial is received.

If needed, use the Application for Fee Review process within the required time.

The benefits you will gain from our services include:

Ability to re-assign staff to other functions.

Greatly improve the efficiency and collections of workers’ compensation payments.